UCSD Human Research Protections Program
 

Sample Informed Consents/Permissions/Assents

UC San Diego, HRPP forms' list

Biomedical | SBS | RCHSD-only | Exempt Status | Expanded Access/Treatment
Biomedical Research Samples
Studies typically conducted by UCSD faculty, staff, and students affiliated with the UCSD Health System and where RCHSD is not a site of performance.
Revised Common Rule version (federally funded only)
Adult (updated 10/1/2013) Adult (released 1/24/2019)
Parent (updated 10/1/2013) Parent (released 1/24/2019)
Adolescent (ages 13-17) (updated 10/1/2013) Adolescent (ages 13-17) (released 1/24/2019)
Child (ages 7-12) (released 6/6/2012)  
Pregnant Partner (released 5/10/2013)  
Audio Recording (updated 6/6/2012)  
Video Recording (updated 6/6/2012)  
Paper Survey (released 3/14/16)  
Online Survey (released 3/14/16)  
Note: Commercial companies sponsoring research often request their own language be used for subject injury or harm clause wording or that minor changes be made to this wording. Such requests cannot be honored. The wording was formulated with the intent of adhering to the requirements of federal regulations and University of California policy and conveying the basic, necessary information to the subject.

These forms are for UCSD salaried faculty, staff and students who are planning research where RCHSD is a site of performance.
Revised Common Rule version (federally funded only)
Adult* (updated 3/22/2016) Adult* (released 1/24/2019)
Parent* (updated 10/1/2013) Parent* (released 1/24/2019)
Adolescent* (updated 10/1/2013) Adolescent* (released 1/24/2019)
Child Assent  
Experimental Subjects' Bill of Rights  
*Includes Experimental Subjects' Bill of Rights
Note: Commercial companies sponsoring research often request their own language be used or that minor changes be made to the HIPAA authorization. Such requests cannot be honored. The wording and formatting used in the authorization was formulated on University of California and RCHSD policy and with the intent of adhering to the requirements of federal and state regulations.
Social and Behavioral Sciences Research Samples
Studies typically conducted by UCSD faculty, staff, and students affiliated with the UCSD campus
Revised Common Rule version (federally funded only)
Adult (updated 10/14/2013) Adult (released 1/24/2019)
Parent (udated 10/14/2013) Parent (released 1/24/2019)
Adolescent (updated 10/14/2013) Adolescent (ages 13-17) (released 1/24/2019)
Child (released 6/6/2012)  
Audio Recording (updated 6/6/2012)  
Video Recording (updated 6/6/2012)  
Paper Survey (updated 3/14/2016)  
Online Survey (updated 3/14/2016)  
RCHSD-only Research Samples
RCHSD researchers that have no affliation with UCSD and are requesting UCSD IRB oversight
Exempt Status Sample
Minimal risk studies that satisfy criteria for exemption from IRB review
Expanded Access/Treatment Samples
The use of an investigational new drug/device outside of clinical trials to treat patients with serious or immediately life-threatening diseases or conditions when there are no comparable or satisfactory alternative treatment options.
Contact the Human Research Protections Program Office